Summary
Definition
Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading. The stability of the spine is not compromised with this type of fracture. These fractures are traditionally considered benign injuries that heal without complications.[1] Rarely, osteoporotic compression fractures can also involve the middle and/or posterior spinal columns, in addition to the anterior column. This type of fracture is potentially unstable and requires surgical intervention. [Figure caption and citation for the preceding image starts]: Lateral radiograph showing a T12 compression fracture in osteoporotic bonePersonal collection of Nasir A. Quraishi [Citation ends].
[Figure caption and citation for the preceding image starts]: Burst fracture with large retropulsed fragment in spinal canal. The patient underwent posterior decompression and stabilizationPersonal collection of Nasir A. Quraishi [Citation ends].
[Figure caption and citation for the preceding image starts]: Vertebral fracture-dislocation. The patient underwent posterior decompression and instrumented stabilizationPersonal collection of Nasir A. Quraishi [Citation ends].
History and exam
Key diagnostic factors
- advanced age
- ethnicity
- previous osteoporotic vertebral compression fracture
- acute back pain
- asymptomatic
Other diagnostic factors
- history of long-term corticosteroid use
- bone-losing medications
- kyphotic deformity
- loss of lumbar lordosis
- localized tenderness
- loss of standing height
- loss of sagittal balance
Risk factors
- older age
- previous osteoporotic vertebral compression fracture
- low body weight
- recent weight loss
- family history of low bone mass/osteoporotic fractures
- smoking
- white or Asian race
- postmenopausal status
- secondary amenorrhea
- alcohol (>2 units/day)
- corticosteroid use
- glucocorticoid excess
- hyperthyroidism
- vitamin D deficiency
- low calcium intake
- rheumatoid arthritis and other autoimmune connective tissue diseases
- endocrine disorders (e.g., hypogonadism, hyperparathyroidism, hyperprolactinemia, acromegaly, hypercortisolism, hyperthyroidism)
- gastrointestinal diseases (e.g., inflammatory bowel disease, celiac disease, malabsorption syndromes, post-bariatric surgery)
- liver diseases (e.g., biliary sclerosis, sclerosing cholangitis, alcoholic cirrhosis, autoimmune hepatitis)
- dietary disorders (e.g., anorexia nervosa/bulimia, inadequate diet, total parenteral nutrition)
- neurologic disorders (e.g., stroke, multiple sclerosis, Parkinson disease, spinal cord injury, long-term immobilization)
- renal disease
- type 1 diabetes mellitus
- organ transplantation
- bone-losing medications
Diagnostic investigations
1st investigations to order
- plain x-rays
Investigations to consider
- CT spine
- MRI spine
- technetium-99m (Tc-99m) whole-body bone scan (bone scintigraphy)
- single-photon emission computed tomography (SPECT)/CT
- bone densitometry scan
- CBC
- bone profile (including serum calcium and alkaline phosphatase)
- C-reactive protein
- blood cultures
Treatment algorithm
anterior column involvement only
multiple column involvement
Contributors
Authors
Nasir A. Quraishi, LLM, FRCS
Consultant Spine Surgeon & Honorary Clinical Associate Professor
Centre for Spinal Studies and Surgery
Queen’s Medical Centre
Nottingham
UK
Disclosures
NAQ declares that his institution has received research support from Medtronic.
Opinder Sahota, FRCP, DM, FHEA
Professor of Orthogeriatric Medicine & Consultant Physician
Queen's Medical Centre
Nottingham University Hospitals NHS Trust
Nottingham
UK
Disclosures
OS declares that he has no competing interests.
Jeremy Fairbank, MD, FRCS
Professor of Spine Surgery
University of Oxford
Nuffield Orthopaedic Centre
Oxford
UK
Disclosures
JF declares that he has no competing interests.
Peer reviewers
Kee D. Kim, MD
Professor of Neurological Surgery
University of California
Davis
CA
Disclosures
KDK declares that he has no competing interests.
Micky Malhotra, MBBS, DTCD, MD, MRCP
Consultant Physician
Wrightington, Wigan & Leigh NHS Foundation Trust
Wigan
UK
Disclosures
MM declares that he has no competing interests.
Differentials
- Muscular pain
- Spinal stenosis
- Pathologic fracture
More DifferentialsGuidelines
- ACR appropriateness criteria: management of vertebral compression fractures
- Guidance for the management of symptomatic vertebral fragility fractures
More GuidelinesPatient leaflets
Osteoporosis: what treatments work?
Osteoporosis: questions to ask your doctor
More Patient leaflets
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